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How Education Affects Congestive Heart Failure

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How does patient education affect compliance with Congestive Heart Failure?

How does education affect compliance with congestive heart failure? I have chosen this topic because congestive heart failure is a disease process that continues to grow throughout our communities. These patients tend to be readmitted into the hospital frequently due to noncompliance.

Problem Identification

Education of congestive heart failure is one of society's largest challenges. The need to focus on compliance of treatment plan, self management, and patient education of this disease process is essential for favorable outcomes. The articles chosen for the information retrieval paper were located on line at the University of Texas at Arlington library in the CINHL database. These articles were written between the years of 2006 and 2009. All three articles were peer reviewed.

While searching the data base for articles, information regarding education, compliance, and outcomes was a key focus. The articles were chosen for their content related to the education process of the patient with congestive heart failure and how compliance would affect outcomes. The knowledge of congestive heart failure of the medical professional was also explored.

Summary of Articles

First article

Congestive heart failure is a debilitating and chronic illness that affects thousands of patients each day. With the rising cost of health care and the increased mortality rate an increased focus has been placed on educating patients along with their families in order to facilitated optimum patient outcomes. When patients gain knowledge regarding their disease process it improves compliance which in turn decreases multiple hospital readmissions which thereby lowers overall cost.

"The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recognizes the importance of providing appropriate educational materials to patients with heart failure" (JCAHO, 2005). Educational materials in writing are to be given to a patient at the time of discharge. Evidence of giving the patient educational instructions on the disease process is expected to be documented in the chart on discharge as well. Guidelines regarding specific educational instructions have been initiated to assure adequate teaching to patients and their families. Despite many attempts to regulate the management of congestive heart failure from various groups the cost of treatment continues to increase, and poor patient outcomes continue to exist.

Studies have been completed to evaluate nurses' knowledge of heart failure self management. "The results of these two studies suggest that nurses routinely caring for patients with heart failure may not be adequately educated in heart failure principles essential for self management" (Washburn, 2008, p.264). Unrealistic expectations are placed on patients to manage their heart failure when inadequate information regarding symptoms, weight management, exercise and medication is given to them. Without both the nurse and patient fully understanding the proper framework of congestive heart failure and how to manage it, poor outcomes are sure to continue to increase along with cost.

Second Article

The importance of education on congestive heart failure at discharge is a key component in improving compliance outcomes. "Patients who are not knowledgeable about their disease and their medications are at a severe disadvantage" (Paul, 2008, p.66). Patient education and their understanding of diet, medication, weight along with activity and the ability to recognize problems early increase the chance of and improved outcome and intervention.

"Joint commission evaluates patients with congestive heart failure by using four performance indicators which include discharge instructions HF-1, assessment of left ventricular function(HF-2), use of angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction(HF-3), and smoking cessation counseling (HF-4)" (Joint Commission, 2008). Written instructions and educational materials are given to patients and or caregivers at discharge. It was found that verbal instruction alone at discharge did not assure patient understanding. When printed educational material was given in combination with verbal instruction the patient's ability to absorb the information was greatly increased (Paul, 2008).

The need for nursing to alter education to a patient's individual learning style is essential in the patients understanding of the disease process. The ability for one to understand, remembers, and applies discharge instructions are a key component of congestive heart failure. The need for families to be included in the discharge instruction is great. They may be needed to reinforce instructions after discharge. Detailed written and verbal instructions containing medications, diet, activity, follow up appointments, weight monitoring and signs and symptoms to report are given to the patient at discharge. Paul (2008) finds that, "Providing comprehensive discharge educations to patients with heart failure is essential to improving outcomes, and cardiac nurses are in a position to take on the role of educator".

Article Three

Patients and nurses alike are challenged when it comes to managing congestive heart failure. As hospital length of stays get shorter, Patients' mental and physical states are being challenged along with increased information regarding their illness. It is vital that a framework for education be initiated upon admission. A study was conducted to examine patient and nurse perception regarding how realistic it is for congestive heart failure patients to learn educational content while in the hospital (Rafii, F., Shahapoorian, F., Azarbaad, M., 2008). In the same study patients rated outcomes significantly higher than nurses. These findings suggest that patients value education highly during their hospitalization for congestive heart failure, and this should be an important focus of nursing care for this population.

Nurses are challenged to provide education to congestive heart failure patients regardless of the many obstacles. Education must be implemented upon admission or when a diagnosis is first made. This would allow the patient and nurse ample time to set priorities, develop educational objectives, and address baseline knowledge of congestive heart failure self-care management. With all these initiated and written and verbal instructions given at discharge a firmer understanding would enhance compliance.



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